Tibialis Anterior (TA) cutaneous reflex (CR) activity evoked following cutaneous stimulation of the plantar (Pl) surface (Pl-TA CR) has demonstrated hyperreflexia and damage of inhibitory mechanisms ...in subjects with spinal cord injury (SCI) and spasticity.
To modulate Pl-TA CR and Soleus H-reflex activity with transcutaneous electrical nerve stimulation (TENS) and vibratory stimulation of the plantar pad during rest and controlled isometric plantarflexion.
Non-injured subjects (n = 11) and individuals with incomplete SCI with (n = 14) and without spasticity (n = 14) were recruited. The effect of TENS and vibratory stimuli on Pl-TA CR and soleus H-reflex activity were assessed during rest and controlled ramp-and-hold plantarflexion.
Vibration failed to inhibit H-reflex activity during rest or plantarflexoin following SCI compared to healthy subjects. In contrast, vibration-induced inhibition of Pl-TA CR was specifically detected in SCI spastic subjects during both rest and the hold phase of plantarflexion. TENS inhibited Pl-TA CR activity in the SCI spasticity group only during hold plantarflexion.
Plantar vibratory stimuli inhibited the pl-TA CR, but not the H reflex, during rest and controlled movement in SCI spastic subjects. Assessment of Pl-TA CR modulation should contribute to the development of modality-specific sensory stimuli programmes for the neurorehabilitation of SCI spasticity.
The aim of the study is to investigate whether transcranial direct current stimulation is superior to control groups or other interventions for pain relief and improving functionality in knee ...osteoarthritis patients.
PubMed, the Physiotherapy Evidence Database, the Cochrane Library, ProQuest, and Scopus databases were searched from inception to July 2022 to identify randomized clinical trials. The main outcomes were subjective perception of pain intensity measured either with the visual analog scale or with the numeric rating scale; and the functionality, assessed with the Western Ontario and McMaster Universities Osteoarthritis Index. As secondary outcomes, pressure pain threshold, conditioned pain modulation, and its safety were evaluated.
We identified 10 randomized clinical trials (634 participants). The results showed an important effect favoring transcranial direct current stimulation for pain relief (mean difference = -1.1 cm, 95% confident interval = -2.1 to -0.2) and for improving functionality (standardized mean difference = -0.6, 95% confident interval = -1.02 to -0.26). There was also a significant improvement in pressure pain threshold (mean difference = 0.9 Kgf/cm 2 , 95% confident interval = 0.1 to 1.6). The certainty of evidence according to Grades of Recommendation Assessment, Development and Evaluation was generally moderate.
Our findings suggest that transcranial direct current stimulation is a safe treatment for reducing pain intensity, improving functionality, and the pressure pain thresholds in patients with knee osteoarthritis.
ResumenObjetivoDeterminar si la estimulación eléctrica nerviosa transcutánea (TENS) tiene un efecto analgésico superior al placebo o a otros tratamientos en pacientes con fibromialgia. Además, se ...pretendía analizar los parámetros de aplicación óptimos para conseguir una mayor reducción del dolor. DiseñoRevisión sistemática. Fuentes de datosEnsayos clínicos aleatorizados sobre el efecto del TENS en la fibromialgia en las bases de datos Pubmed, Cochrane y PEDro hasta noviembre de 2016. Selección de estudiosSe seleccionaron 8 estudios de un total de 62. Se incluyeron ensayos clínicos controlados en los que se aplicase TENS a personas con fibromialgia. Extracción de datosSe analizó el dolor como variable principal, aunque también se incluyeron otras variables como fatiga, calidad de vida e impacto de la enfermedad, recorrido articular y depresión. ResultadosSeis de 8 trabajos obtuvieron una disminución significativa del dolor. En 2 estudios se aplicó el TENS como tratamiento complementario al ejercicio terapéutico con resultados evidenciando una disminución del dolor. El resto de variables estudiadas presentaron gran variabilidad y no se pudieron establecer resultados concluyentes. ConclusionesEl tratamiento con TENS resulta efectivo para la disminución del dolor en personas con fibromialgia. Además, la inclusión del TENS en programas de ejercicio terapéutico parece tener un efecto superior a la realización del ejercicio terapéutico de forma aislada. Sin embargo, no se ha demostrado eficacia en otras variables diferentes al dolor. Son necesarios más estudios que indaguen en la optimización de los parámetros del TENS y un mayor consenso entre las variables utilizadas.
This case report describes the long-term effect of the high-intensity laser therapy (HILT) in a patient with chronic shoulder pain refractory in comparison to other treatments.
Ten sessions of HILT ...were applied in a thirty-one-year-old woman diagnosed with subacromial syndrome. Assessment was carried out through different tests: Shoulder Pain and Disability Index (SPADI), Numeric Pain Rating Scale (NPRS) and pressure pain threshold (PPT). All measurements were taken at four different points: at the end of the 10 sessions, after one month, three months after the intervention and nine months after the initial intervention.
There was a clinically significant improvement in NPRS (decrease of 5 points), PPT (increase of 1.5 kg/cm2) and SPADI (decrease of 24 points) one month after the intervention. After three months, the increase of NPRS and SPADI required a 5-session intervention to support the clinical improvement. Six months after these booster sessions an increase in PPT and a decrease in NPRS and SPADI were observed.
Results indicate the suitability of developing new research lines which will optimize the use of HILT.
The aim of the study is to examine the effectiveness of extracorporeal shockwave therapy in reducing pain, improving functionality, joint range of motion, quality of life, fatigue, and health status ...self-perception in people with myofascial pain syndrome.
PubMed, the Cochrane Library, CINAHL, the Physiotherapy Evidence Database, and SPORTDiscus were systematically searched for only randomized clinical trials published up to June 2, 2022. The main outcome variables were pain, as reported on the visual analog scale and pressure pain threshold, and functionality. A quantitative analysis was conducted using the inverse variance method and the random effects model.
Twenty-seven studies were included ( N = 595 participants in the extracorporeal shockwave therapy group). The effectiveness of extracorporeal shockwave therapy for relieving pain was superior for the extracorporeal shockwave therapy group compared with the control group on the visual analog scale (MD = -1.7 cm; 95% confidence interval = -2.2 to -1.1) and pressure pain threshold (mean difference = 1.1 kg/cm 2 ; 95% confidence interval = 0.4 to 1.7) and functionality (standardized mean difference = -0.8; 95% confidence interval = -1.6 to -0.04) with high heterogeneity. However, no differences were found between extracorporeal shockwave therapy and other interventions as dry needling, exercises, infiltrations, and lasers interventions.
Extracorporeal shockwave therapy is effective in relieving pain and improving functionality in patients with myofascial pain syndrome compared with control and ultrasound therapy.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
Upon completion of this article, the reader should be able to: (1) Determine the effectiveness of radial and focal extracorporeal shockwaves on pain perception, the pressure pain threshold, and functionality in people with myofascial pain syndrome; (2) Describe the intervention protocol of extracorporeal shockwave therapy to improve pain perception in people with myofascial pain syndrome; and (3) Describe the advantages and disadvantages of extracorporeal shockwave therapy versus other intervention such as dry needling.
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The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Advanced.
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
RESUMEN La incontinencia fecal supone un importante impacto en la calidad de vida, produciendo estigmatización y exclusión social. La electroestimulación del nervio tibial posterior se emplea como ...técnica de tratamiento de la misma. La presente revisión sistemática tiene por objeto evaluar la eficacia de esta técnica en el tratamiento de la incontinencia fecal. La búsqueda bibliográfica en PubMed, Scopus, Web of Knowledge y PEDro se desarrolló siguiendo la declaración Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), e incluyó ensayos clínicos aleatorizados y series de casos. Las medidas de resultado fueron la eficacia del tratamiento, la severidad de la incontinencia y la calidad de vida, tanto para la estimulación percutánea como transcutánea a corto, medio y largo plazo. Veintitrés estudios reunieron los criterios de selección. Dos ensayos clínicos obtuvieron diferencias significativas respecto al placebo, en términos de eficacia del tratamiento. Quince series de casos concluyeron con mejoras significativas en términos de eficacia, severidad y calidad de vida. Todos los ensayos clínicos y series de casos consiguieron reducir los episodios incontinentes y aumentar el tiempo de aplazamiento de la defecación. Programas de una o dos sesiones por semana, de 30 a 60 minutos, con anchura de pulso de 200 microsegundos y frecuencias de 10-20 hertzios son los óptimos para obtener estos resultados. No se ha demostrado superioridad de la estimulación percutánea frente a la transcutánea. La ENTP resulta efectiva en el tratamiento de la incontinencia fecal aunque se requieren tratamientos a largo plazo para consolidar los efectos de la técnica.
Botulinum toxin type A (BTX-A) intramuscular injections have been used for the treatment of myofascial pain syndrome (MPS), although its efficacy remains still unknown and its safety is ...controversial.
To analyze the effectiveness and safety of the injection protocol for BTX-A in the shoulder-scapular and lumbar-pelvic girdles combined with physiotherapy in patients with primary and secondary MPS.
Retrospective descriptive study including 301 medical files of patients with persistent MPS. Positive responses to treatment were considered to be a satisfactory level of effectiveness with 50% pain relief or a fully satisfactory level of effectiveness at 80%.
Overall, 58.1% of patients obtained a positive result at 6 months. Differences in effectiveness were found between primary MPS (82.9% of patients) and secondary MPS (54.9%; p=0.002). In patients with secondary MPS, differences in effectiveness arose based on pathologies associated with MPS (p=0.03). In 23.9% of cases, mild and temporary adverse effects were observed post-infiltration.
BTX-A injections and physiotherapy is an alternative to conventional treatment which should be considered when treating refractory MPS. Nonetheless, the differences in effectiveness based on diagnosis suggest the need to clarify the criteria used to select patients with MPS in future clinical trials and applications.
Fecal incontinence severely impacts on quality of life, causing stigmatization and social exclusion. Posterior tibial nerve stimulation (PTNS) is one technique used for treatment. This systematic ...review aims to assess the effectiveness of PTNS for the treatment of fecal incontinence. A literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) declaration. Pubmed, Scopus, Web of Knowledge and PEDro databases were searched for both randomized clinical trials and cases series. The outcome variables were treatment effectiveness, severity of incontinence and quality of life; all were measured in the short, mid and long-term after performing both percutaneous and transcutaneous PTNS. Twenty-three studies met the selection criteria. Two clinical trials found significant differences in treatment effectiveness compared to the placebo response. Fifteen cases series observed significant differences in terms of effectiveness, severity and quality of life. All clinical trials achieved a reduction in the number of incontinence episodes and an increase in the deferral time for defecation. Optimal results were achieved by interventions consisting of one or two weekly sessions of a 30-60 minutes duration and the use of pulse widths of 200 micros and frequencies of 10-20 Hz. Percutaneous stimulation did not demonstrate better results compared to transcutaneous application. PTNS is an effective technique for the treatment of fecal incontinence, although long-term interventions are required in order to prolong its effects in the long-term. Key words: Transcutaneous electrical nerve stimulation. Percutaneous electrical nerve stimulation.
BACKGROUNDApproximately 65%-78% of patients with a spinal cord injury (SCI) develop any symptom of spasticity. The aim of this study was to investigate the tolerability and short-term effects of ...radial extracorporeal shock wave therapy (rESWT) on plantar flexor spasticity in a patient with incomplete SCI. CASE SUMMARYAn 18-year-old man with an incomplete SCI completed five sessions of rESWT. The primary outcomes were the changes in ankle-passive range of motion (A-PROM) and passive resistive force to ankle dorsiflexion. The outcomes were assessed at baseline (T0), immediately after treatment (T1) and 1 wk after the end of treatment (T2). The A-PROM increased by 15 degrees at T1 and 25 degrees at T2 compared with T0. The passive resistive force to ankle dorsiflexion at low velocity decreased by 33% at T1 and 55% at T2 in the gastrocnemius muscle and by 41% at T1 and 39% at T2 in the soleus muscle compared with T0. At high velocity, it also decreased by 44% at T1 and 30% at T2 in the gastrocnemius muscle compared with T0. However, in the soleus muscle, the change was minor, with a decrease of 12% at T1 and increased by 39% at T2 compared with T0. CONCLUSIONIn this patient, the findings showed that rESWT combined with conventional therapy was well-tolerated and could be effective in improving A-PROM and passive resistive force to ankle dorsiflexion in the short-term. Further randomized controlled clinical trials with longer period of follow-up are necessary to confirm the results obtained in patients with SCI.
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